Prevention/Care Management, 2007

Indiana State Department of Health

September 2007

The Indiana General Assembly passed a bill in 2007 eliminating scoliosis testing in Indiana public schools. The bill removed the requirement that schools check students in fifth, seventh, and ninth grades for scoliosis, a medical condition where the spine is laterally curved. This legislative repeal was an important collaboration between the Indiana State Department of Health (ISDH), the Indiana Department of Education (DOE), and the Indiana Chapter of the American Academy of Pediatrics.

In deciding to end the free screening program, State Health Commissioner Judith Monroe, MD, states, "We used the U.S. Preventive Services Task Force recommendation on scoliosis screening to make our decision. The Task Force statement is evidence-based and provides a sound basis for a public health recommendation to repeal the current school scoliosis screening requirement."

The bill repealing scoliosis screening was introduced by Senator Patricia Miller, RN, a longtime leader in the Indiana General Assembly and Chair of the Health and Provider Services Committee. The bill was one of several related to school health and safety issues introduced during the 2007 session.

Charlene Graves, MD, a pediatrician and medical director at the ISDH, provided testimony to the Indiana Senate Committee on Health and Provider Services during a hearing on the legislation. Dr. Graves provided a review of medical information pertinent to the problems associated with scoliosis screening methods. She also informed the Senate Committee that the Task Force concluded that routine scoliosis screening in schools is not an effective public health measure.

"Only about two out of every 1,000 cases becomes serious enough to require treatment," noted Graves. "Graves stated the benefits of school scoliosis screening process are outweighed by the extensive time commitment and the costs mostly associated with many unnecessary referrals to family physicians and follow-up x-rays.

In bringing the proposed policy change to the forefront, the ISDH and DOE concluded that school scoliosis screening was causing the health care system unnecessary expenses. The State also concluded the time and effort of school nurses doing such screening could be more productively directed to other health issues, such as diabetes and asthma, which affect many more students.

The U.S. Preventive Services Task Force recommends against the routine screening of asymptomatic adolescents for idiopathic (without a known cause) scoliosis. Good evidence is lacking to show that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening.

The accuracy of the most common scoliosis screening test—the forward-bending test with or without a scoliometer—in identifying adolescents with idiopathic scoliosis is variable.

There is also evidence of poor follow-up of adolescents with idiopathic scoliosis who are identified in community screening programs. As a result, the harms of screening adolescents for idiopathic scoliosis exceed the potential benefits, according to the Task Force.

Monroe states, "We are actively reviewing our practices and policies in Indiana in light of the Task Force recommendations and modifying when appropriate based on the evidence." While scoliosis screening is still mandated in many states, others are beginning to review the requirement; some have already eliminated mandatory screening.

In June 2006, the State was influenced by the Task Force recommendations to end a free bone density screening program based on heel ultrasound. (Go to Multi-Center 06-03 Impact Case Study.)

Impact Case Study Identifier: CP3 07-06
AHRQ-Sponsored Activity: U.S. Preventive Services Task Force (USPSTF)
Topic(s): Prevention, Pediatrics, Policy
Scope: Indiana

U.S. Preventive Services Task Force. Screening for Idiopathic Scoliosis in Adolescents: A Brief Evidence Update for the U.S. Preventive Services Task Force. June 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.uspreventiveservicestaskforce.org/3rduspstf/scoliosis/scolioup.htm

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